week 9 Flashcards
what are indications for supplemental oxygen
Arterial hypoxaemia
oxygen saturation of less than 90%
an oxygen tension (PaO2) of less than 60mmHg
Failure of oxygen–haemoglobin transport system resulting in tissue hypoxia.
Reduced oxygen-carrying capacity in blood (e.g. anaemia, carbon monoxide poisoning).
Reduced tissue perfusion (e.g. shock).
Hypercapnoeic respiratory failure (type II)
Respiratory distress
supplemental oxygen considerations and risk
-Children – humidified, high-flow oxygen is a method of choice → to reduce adverse events of hypothermia and insensible water loss.
-Children - Aim is to reduce work of breathing, hypoxaemia, ensure adequate clearance of secretions and limit adverse events mentioned above.
-Pregnant women (more then 20 weeks) with hypoxaemia managed with left lateral tilt.
-In the acute situation, inadequate oxygen therapy accounts for more deaths and permanent disability than high concentrations of oxygen.
-Exposure to high concentrations of inspired oxygen can cause absorption atelectasis and injury to airways and lung parenchyma.
supplemental oxygen considerations pt 2
if patient has chronic lung disease COPD high oxygen may lead to worsening hyperpnoea, reduced consciousness and resp arrest
- oxygen is reduced is supine position(layingdown) therfore patients should be in fowlers position
exceptions include skeletal or spinal trauma, patient is hypotensive, patient has significan altered conscious state or recovering from seizure
oxygen is prescribed unless
oxygen is a medication and must be written in med chart.
eccception emergency, icu,operating theatre, pacu and post operative period, ED
oxygen delivery devices
nasal cannula: low flow type of oxygen, 2-4L/min, 24-36%
Hudson mask: low flow type of oxygen delivery, 5-8L/min 40-5-%
non-rebreather mask low flow 10-15L/min 85-100%
venturi mask high floe air entrapment device flow rate ranges from 2-14 depending on what control meter is attached same had FIO2 % around 24-55%
what is the selection of delivery method
Oxygen delivery method selected depends on:
age of the patient
oxygen requirements/therapeutic goals
patient tolerance to selected interface
humidification needs
what are low and high flow delivery methods for exygen ?
LOW:
Hudson mask
Non re-breather face mask
Nasal prongs (low flow)
Tracheostomy mask
Tracheostomy HME connector
Isolette - neonates
HIGH:
Venturi system
Ventilators
CPAP/BiPaP
Face mask or tracheostomy mask used in conjunction with an Airvo2 Humidifier (most common in paediatrics)
High Flow Nasal Prong therapy
Paediatrics: Indications for Humidification
Patients with thick copious secretions
Non-invasive and invasive ventilation
Nasal prong flow rates of greater than 2 LPM (under 2 years of age) or 4 LPM (over 2 years of age)
Nasal prong flow rates of greater than 1 LPM in neonates
Facial mask flow rates of greater than 5 LPM
Patients with tracheostomy
Benefits and disadvantages of nasal cannula
The actual inspired oxygen concentration varies between patients because of differences in their pattern of breathing.
Mouth breathing does not appear to reduce the efficacy of nasal cannula.
Preferred by patients due to comfort, ability to speak and eat and less claustrophobic than masks.
Flow rates above 4 L/min tend to cause nasal dryness and discomfort for patients.
when would you not use a nasal cannula/ considerations
Nasal trauma.
Nasal injury including epistaxis +/- packing
Nasal blockages/obstruction
cause of acute upper airway obstruction
-Most common cause of acute upper airway obstruction in children is croup.
Due to their size, infants are most at risk of severe upper airway obstruction.
-Most common cause in the unconscious patient is the tongue.
-Other causes of acute upper airway obstruction across the lifespan include:
anaphylaxis
peritonsillar abscesses (quinsy)
bacterial infections (e.g. tracheitis, severe tonsillitis)
inhaled foreign body
airway burns
trauma
asthma
sublingual and submandibular infections
obstructive sleep apnoea
signs and symptoms for paediatrics of mild obstruction
Able to speak or cry, may be hoarse Intermittent stridor or occasional stertor Minimal or no work of breathingGood air entry
signs and symptoms for paediatrics of moderate obstruction
Tachypnoea
Stridor
Prolonged inspiratory time
Moderate work of breathing, nasal flaring. grunting, paradoxical chest movement
Decreased air entry
signs and symptoms for paediatrics of severe to complete obstruction
Hypoxia (late sign)
Slow respiratory rate or marked tachypnoea
Sniffing or tripod position
Agitated or drowsy conscious state
Severe work of breathing
Markedly reduced or no air movement
Silent gagging or coughing
Total obstruction will rapidly progress to unconsciousness and cardiorespiratory arrest
management of acute upper airway obstcuction
MET
emergency airway manoeuvres
suction tilt head for adults natural head postition for infants, and ‘sniffing’ head position for 2-8 year-old
supplemental oxygen but won’t relive obstruction
if anaphylaxis addition of adrenaline
medication
